and then score on the pp

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For my Akashi-kun, @hanyamiya. I’m sorry it’s so short, I really didn’t have time like I expected to. I’m sorry for any plot holes, but I hope you like it. PS it’s only like 3,000 words it might be a bit short but I had nO TIME OKAY. PPS I might rewrite this later when I have the time. But for now enjoy ur crack


If you were looking for the official definition for the word sweet, chances were you’d find a photo of Kuroko Tetsuya. Akashi guaranteed, there was nothing and no one who was sweeter than Kuroko.

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Increased Intracranial Pressure

(>20 mm Hg) Due to a rigid and fixed skull, there is no room for any additional fluid, blood, or lesions. Additional matter without an expansion of volume, especially, creates increased pressure. Increased intracranial pressure is very serious and could lead to brain herniation and subsequent death.

Causes

  • Brain tumors
  • CNS infections
  • Cerebral edema
  • Intracranial bleeding
  • Excess CSF

Manifestations

  • Changes in level of consciousness (LOC) ***often the first indication***

Glasgow Coma Scale measures LOC via eye, motor, and verbal responses to stimulus from the environment. It scores from 3-15 w/ 8 being the “magic number” - think magic 8 ball. If you shake it up, or stimulate it, and a number < 8 appears a severe coma is present. 9-12 represents a moderate coma. 13-14 represents a mild coma.

  • Blurred vision
  • Coma
  • Decerebrate posture (extension of arms indicative of brain stem involvement)
  • Diplopia
  • Doll’s eye phenomena
  • Headache
  • Projectile vomiting
  • Behavior changes
  • Seizures
  • Cushing’s reflex (as manifested by Cushing’s triad):  increased BP w/ widening PP (peripheral resistance increased to shunt blood towards the oxygen-needy brain), decreased pulse rate (in a vagal-induced response to rising BP), decreased/irregular (Cheyne Stokes) respirations

Indicative of impending herniation - emergent medical response necessary.

Treatment of ICP

  • Keep HOB elevated at 30 degrees
  • Keep patient well hydrated
  • Frequent neuro-checks needed
  • Strict I&O
  • Anticonvulsants for seizure prevention (phenytoin)
  • Mannitol (osmotic diuretic used to reduce cerebral edema)
  • Loop diuretics
  • Avoid aspirin, narcotics, or meds that depress respirations (as they are already at risk for being low)
  • Hyperventilate patient (blow off CO2 [hypocapnia]) to decrease cerebral blood flow (cerebral vasoconstriction in response to low CO2 levels)
  • Decrease environmental stimuli
  • initiate seizure and safety precautions (padded side rails up, call light w/in reach)

THE PENS WIN IT IN OVERTIME OVER THE JETS…AND TO MAKE IT MORE PERFECT SID GETS THE GAME WINNER! THEY STARTED THIS GAME WITH A QUICK GOAL FROM GENO, THEN ADDED ANOTHER FROM KUNI WHICH RESULTED IN SID GETTING HIS 1000TH POINT…AND HONESTLY IT WAS KIND OF SPECIAL FOR IT TO COME ON A KUNI GOAL! THEY GOT INTO A BIT OF INJURY PROBLEMS IN THE 2ND PERIOD (SCHULTZ & MAATTA) SO THEY WERE PLAYING WITH ONLY 4 D-MEN FOR A GOOD AMOUNT OF THE GAME! A TIMELY PP GOAL FROM PHIL AND THEY WERE ABLE TO TIE THE GAME IN THE 3RD TO GET IT TO OVERTIME AND FLOWER PLAYED GREAT TOO!!

Final: Pens 4 Jets 3  OT

Goals: Evgeni Malkin, Chris Kunitz, Phil Kessel, & Sidney Crosby

CONGRATS TO TANGER ON PLAYING IN HIS 600TH NHL GAME! AGAIN A HUGE CONGRATS TO SID ON GETTING TO THAT 1000 POINT MILESTONE – 12TH FASTEST TO REACH 1000! PHIL THE THRILL HAS NOW SCORED IN 4 STRAIGHT GAMES…INCLUDING A COUPLE TYING GOALS! HOPEFULLY SCHULTZ AND MAATTA AREN’T OUT LONG OR AT ALL WOULD BE NICE…NEXT GAME IS TOMORROW NIGHT VS – THE DIVISIONAL RIVALS – THE BLUE JACKETS!

LETS GO PENS!!

10

Blood, sweat, the heart of a lion, and a Stanley Cup. There’s a lot that can be said of the Bruins in the last 5 years, but one of the constants was Gregory Campbell. He was never a superstar, he never stood out on a box score or an award race, but this guy is tough as nails. For 5 years Soupy centered arguably the best 4th line in hockey and was always willing to stick his nose in the dirty areas to stick up for his teammates or score a dirty goal. He never backed down from a challenge, as he fought guys with big size and strength advantages, he killed penalties, he even killed a penalty on a broken right tibia against a team that could’ve been the best PP in the league. Personally I’ll never forget him carrying a stack of pies on Behind the B as he was preparing to help those less fortunate than himself on thanksgiving. I’ll never forget seeing a picture of the Campbell’s Soup can that he signed.

Once a Bruin always a Bruin

The courage of an entire city exemplified in a single shift.